rome and Tuberculosis

The results of tuberculosis (TB) screening and reactivation in a cohort of 323 adult patients undergoing haematopoietic stem cell transplantation (HSCT) from 2015 to 2019 at the University Hospital of Tor Vergata, Rome, Italy, were reported. A total of 260 patients, 59 (18.3%) autologous and 264 (81.7%) allogeneic transplants, underwent Interferon Release (IFN)-γ (IGRA) test screening: 228 (87.7%) were negative, 11 (4.2%) indeterminate and 21 (8.1%) positive. Most of the IGRA-positive patients were of Italian origin (95.2%) and significantly older than the IGRA-negative (

Topics: Adult; Cohort Studies; Hematopoietic Stem Cell Transplantation; Hospitals; Humans; Interferon-gamma Release Tests; Latent Tuberculosis; Retrospective Studies; Rome; Tuberculin Test; Tuberculosis

Vulnerable populations are being more severely impacted by the ongoing pandemic, and the recent release of vaccines for Coronavirus Disease 19 (COVID-19) may offer them protection. The aim of this study was to investigate the willingness of homeless persons to be vaccinated against COVID-19; secondary aims were to analyze the immunization coverage for other conditions.. The acceptance of COVID-19 vaccine and immunization coverage for other conditions were investigated through a form in 112 persons experiencing homelessness referring to the primary care medical services of the Eleemosynaria Apostolica, Holy See.. Most subjects, with a male preponderance, were willing to be vaccinated against COVID-19 (64.3%), 3.6% were unsure and 32.1% preferred not to be vaccinated. When answering questions on the immunization coverage for tuberculosis and hepatitis A and B, most subjects reported not to be vaccinated (48.2%, 56.2% and 55.3%, respectively) or did not know (33%, 28.6% and 27.7%).. A significant portion of our sample declared to be willing to be vaccinated against COVID-19. It would be auspicious that the recent statements from several countries on the importance to extend COVID-19 vaccination to fragile populations be followed by the distribution of the vaccine to these populations.

Topics: Adult; Aged; Attitude to Health; COVID-19; COVID-19 Vaccines; Female; Hepatitis A; Hepatitis A Vaccines; Hepatitis B; Hepatitis B Vaccines; Humans; Ill-Housed Persons; Influenza Vaccines; Influenza, Human; Male; Middle Aged; Patient Acceptance of Health Care; Rome; SARS-CoV-2; Tuberculosis; Tuberculosis Vaccines; Vaccination Coverage; Young Adult

In Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers.. Presence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup.. Among 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis.. The overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.

Topics: Adult; Africa South of the Sahara; Female; Humans; Male; Mass Screening; Middle Aged; Prevalence; Preventive Health Services; Refugees; Rome; Tuberculosis

Tuberculosis is the second leading cause of death from infectious disease. Insufficient knowledge among doctors about tuberculosis is one of the reasons for the increased tuberculosis rates in several low-endemic countries. The purpose of this study was to assess knowledge, experience, and attitude about tuberculosis among medical students.. After a pilot study, a cross-sectional survey was performed on fifth-year medical students at the Catholic University of Rome (Italy), using a self-administered questionnaire on attitude, experience and knowledge about epidemiology, diagnosis, and treatment of tuberculosis. The t test and multivariable linear regression analysis were performed to estimate the association between TB knowledge and investigated variables.. Among 220 fifth-year medical students, the response rate was 83.1%. The mean percentage of correct answers was 56.6% (63.5% for epidemiology and prevention, 54.1% for diagnosis, and 45.7% for treatment). Associations between internships in wards and greater knowledge of tuberculosis diagnosis (55.9% vs. 51.6%, p=0.02), treatment (48.4% vs. 41.8%, p=0.03) and total score (58.1% vs. 54.5%, p=0.04) were found. Students who reported receiving the Mantoux test had higher knowledge of tuberculosis epidemiology and prevention (65.4% vs. 53.3%, p=0.001), diagnosis (55.2% vs. 48.3%, p=0.005), and total score (58.0% vs. 49.1%, p=0.001). Students who had observed at least 1 active pulmonary tuberculosis case had a higher percentage of correct answers about diagnosis (55.5% vs. 51.4%, p=0.03) and total score (57.9% vs. 54.0%, p=0.03). The multivariable linear regression confirmed the association between higher knowledge and receiving the Mantoux test (beta coefficient=7.2; 95% CI 2.6-11.7), as well as having observed at least 1 X-ray of a TB patient (beta coefficient=5.3; 95% CI 1.0-9.7).. A moderate level of general knowledge about tuberculosis was found, which suggests the need to modify current programs of infectious diseases in the curriculum of medical schools.

Topics: Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Linear Models; Male; Rome; Students, Medical; Tuberculosis; Young Adult

The authors show the results of an integrated model for risk management of tuberculosis in a sample of sheltered homeless in Rome. Tuberculin skin test (TST) was used for evaluating the prevalence of latent infection (LTBI). In TST positives, expectorate was collected and chest X-ray was achieved. Multiple logistic regression analysis was performed to investigate determinants of infection. Out of 288 recruited subjects, 259 returned for the TST reading; 45.56% were positive and referred to a specialized center; 70 accessed the health facility and completed the clinical pathway. The risk factors associated to LTBI were male gender (OR = 3.72), age over 60 years (OR = 3.59), immigrant status (OR = 3.73), and obesity (OR = 2.19). This approach, based on an integrated social network, guarantees high adherence to screening (89.93%), allowing patients testing positive for latent tuberculosis infection to be diagnosed and rapidly referred to a specialized center.

Topics: Adult; Female; Humans; Ill-Housed Persons; Logistic Models; Male; Middle Aged; Models, Statistical; Prevalence; Risk Management; Rome; Tuberculosis

Tuberculosis (TB) is among the top 10 causes of child death worldwide. Nevertheless, childhood disease has been neglected by tuberculosis control programs.. This was a retrospective study of patients < 16 years of age diagnosed with active TB in 2 tertiary hospitals in Rome (Italy), between 1990 and 2009.. Two hundred fourteen cases of active tuberculosis were identified (132 definite, 82 probable). Pulmonary involvement was the most common form (75.5%), followed by lymphadenopathy (15.4%) and central nervous system TB (11%). Fever (51.86%) and cough (40%) were the most common presenting symptoms. A total of 23.4% of children were asymptomatic on admission. Sensitivities of the tuberculin skin test and the quantiferon test were 93.4% and 97%, respectively. Both tests performed in 52 children agreed in 49 cases (94%). Sensitivities for culture, Ziehl-Neelsen staining and polymerase chain reaction were 58%, 25% and 66.3%, respectively. The adult source case was identified in 28% of cases. History of contact with a patient with active TB was associated with pulmonary TB (P = 0.0014), whereas negative history of contact was associated with lymph node (P = 0.0064) and central nervous system TB (P = 0.05).. Our study emphasizes the difficulty in managing children with suspected TB, because the absence of constitutional symptoms cannot exclude TB, and bacteriologic confirmation is the exception. Immunologic diagnosis can be a valuable tool to identify TB-infected children because the quantiferon test showed high sensitivity in all age groups. This is of primary importance because early identification of children with latent tuberculous infection and appropriate chemoprophylaxis represent, to date, the most important tool to reduce the burden of TB.

Topics: Adolescent; Adult; Bacteriological Techniques; Child; Child, Preschool; Female; Humans; Immunoassay; Infant; Male; Retrospective Studies; Rome; Tertiary Care Centers; Tuberculosis

An out-patient clinic for immigrants in Rome, Italy.. To determine risk factors for tuberculosis among immigrants in Italy.. Case-control study. Cases comprised 44 individuals aged 15-55 years who had a first diagnosis of tuberculosis between 1989 and 1994 at the clinic. Controls comprised 264 individuals randomly recruited among immigrants who attended the clinic for other reasons within seven days before or after the case was diagnosed. Subject information included country of origin, date of first arrival in Italy, level of education, knowledge of the Italian language, and legal resident status.. An increase of tuberculosis risk was observed with increasing tuberculosis incidence in the country of origin. Multivariate analysis showed an increased risk for those coming from Central and South America (odds ratio [OR] 5.5; 95% confidence interval [CI] 1.6-18.7). The adjusted odds ratio by time since entry in Italy increased during the second year of residence (OR 2.8; 95% CI 1.1-7.0), but decreased after that period. A trend toward increasing risk with decreasing educational level was observed.. These results demonstrate the need for a public health policy in Italy for tuberculosis control among immigrants which includes screening, prophylaxis and treatment.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Case-Control Studies; Central America; Emigration and Immigration; Female; Humans; Incidence; Male; Middle Aged; Odds Ratio; Risk Factors; Rome; Socioeconomic Factors; South America; Tuberculosis

All Italian citizens are covered by the National Health Service (NHS) and medical records of individual drug prescriptions are routinely collected and processed. A procedure entitled EPIFAR has been developed which, on the basis of a computer routine, makes it possible to trace back the prescription history of each individual included in the NHS. The validity of information gathered through the EPIFAR procedure to provide estimates of tuberculosis (TB) prevalence has been evaluated. A comparison with routine surveillance data has been made. The EPIFAR procedure identified a total figure of TB patients seven times higher than that from official notifications. A sample survey was conducted among the prescribing physicians in order to quantify the proportion of TB cases among subjects receiving prescriptions of anti-TB drugs. According to general practitioner recall 66.4% of the patients were treated because of TB diagnosis, TB prophylaxis and TB relapse.

Topics: Antitubercular Agents; Drug Prescriptions; Drug Utilization; Epidemiologic Methods; Evaluation Studies as Topic; Humans; Models, Statistical; Population Surveillance; Prevalence; Reproducibility of Results; Rome; Tuberculosis

Topics: Biometry; Italy; Rome; Statistics as Topic; Tuberculosis